Stereotactic Approach to the Trigeminal Ganglion Using a Stereotactic Frame and Intraoperative Computed Tomography Scans: Technical Note.
Journal - Stereotactic and functional neurosurgery
Objective: In this paper, a technique to place a probe at the trigeminal ganglion using a stereotactic frame and intraoperative computed tomography (CT) scans is described. Method: The procedure is performed on the CT table using a stereotactic frame. After the coordinates have been obtained and then adjusted, the target is probed using the frame. In this study, intraoperative scans were obtained to confirm the accuracy of probe placement. After successful stimulation studies, radiofrequency lesions were made. Thirty-two procedures were performed on 26 patients. Results: Twenty patients were free of pain at a follow-up which lasted a median of 30 months. There was no permanent complication from the procedure. Conclusions: The technique is straightforward, accurate and safe. It also enables the surgeon to obtain intraoperative confirmation of accurate probe placement on CT images.Copyright © 2010 S. Karger AG, Basel.
A modified stereotactic frame as an instrument holder for frameless stereotaxis: Technical note.
Journal - Surgical neurology international (India )
BACKGROUND: In order to improve the targeting capability and trajectory planning and provide a more secure probe-holding system, a simple method to use a stereotactic frame as an instrument holder for the frameless stereotactic system was devised. METHODS: A modified stereotactic frame and BrainLab vector vision neuronavigation sys¬tem were used together. The patient was placed in the stereotactic head-holder to which a reference array of the neuronavigation system was attached. The pointer of the frameless system was placed in the probe-holder of the frame. An offset in distances was kept between the radius of the arch of the frame and the tip of the pointer so that the pointer was always outside the head during navigation. The offset correction was made on the BrainLab monitor so that the center of the arc of the frame was at the tip of the probe line on the monitor. Then, using the frame's coordinate adjuster system, the center of the arc was positioned on the target. This method was used to insert depth electrodes (seven procedures) and gain access to the temporal horn (three procedures). RESULTS: Post-operative scans showed that the accuracy was within 2.5 mm in all three planes for depth electrode placement, and easy access to the temporal horn was obtained in two other patients. CONCLUSION: This is a simple method to use a stereotactic frame to improve coordinate and trajectory adjustments and provides a better method to stabilize the pointer and the probe-holder during frameless stereotactic procedures.
Is epilepsy surgery on both hemispheres effective?
Journal - Stereotactic and functional neurosurgery (Switzerland )
BACKGROUND: Patients with bilateral independent seizure foci are poor candidates for conventional resective epilepsy surgery. The authors have therefore used minimally invasive procedures to treat such patients. In this paper, the result of a large series of patients treated by this approach is examined to determine the effectiveness of this approach. MATERIALS AND METHODS: The series had 61 patients. The range of follow-up was 15-90 months. The mean follow-up was 41.5 months with a median of 37 months. Patients' ages at the time of surgery ranged from 3 to 54 years, with a mean of 11.3 and median of 6. Male to female ratio was 39/22. Fifty patients had complex partial seizures, 3 had Lennox-Gastaut syndrome, 4 had myotonic seizures, 2 had infantile spasm, and 2 had myoclonic seizures. Preoperative evaluation included: video electroencephalogram (EEG) monitoring using scalp electrodes, neuropsychological evaluation, magnetic resonance scans, positron emission topography and/or single photon emission computed tomography scans, magnetoencephalogram, Wada test and video EEG recording using subdural electrodes. Multiple subpial transection (MST) was the principle procedure. This procedure was supplemented (17 patients) with minimal cortical resection when intraoperative electroencephalogram indicated that an area failed to respond to MST. When an additional epileptogenic focus was present in the amygdala-hippocampus complex (5 patients), it was treated with stereotactic amygdala-hippocampotomy. The eloquent cortex was treated in 51 patients. The number of lobes treated was 2 in 5 patients, 3 in 5 patients, 4 in 10 patients, 5 in 2 patients, 6 in 38 patients and 8 in 1. RESULTS: Seizure outcome based on Engel's modified classification was as follows: 32 patients (52.45%) were class I, 5 (8.2%) were class II, 15 (24.59%) were class III, 3 (4.9%) were class IV and 6 (9.83%) were class V. There was no statistical difference between those who were operated on of the first half of the series and those who were operated on of the second half of the series (p = 0.1636). Similarly, there was no statistical difference between this series and two large series in which MST had been performed on one hemisphere (p values of 0.6863 and 0.7337). There was no statistical difference between those who had MST alone and those who had MST plus minimal cortical resection (p = 0.1698). There was no permanent neurological complication in this series. CONCLUSION: Patients with intractable epilepsy with independent seizure foci in both hemispheres can be safely treated with the approach described in this paper, and seizure control achieved by this approach is fairly satisfactory and similar to that reported in patients with surgery on one hemisphere.
|ISSN : ||1011-6125|
|Mesh Heading : ||Adolescent Adult Cerebral Cortex Child Child, Preschool Epilepsy Female Follow-Up Studies Hemispherectomy Humans Male Middle Aged Treatment Outcome physiology physiopathology statistics & numerical data|
|Mesh Heading Relevant : ||surgery surgery methods|